Adult sleep apnea syndrome including obstructive sleep apnea hypopnea syndrome (obstructive sleep apnea-hypopnea syndrome, OSAHS) and centra
Adult sleep apnea syndrome including obstructive sleep apnea hypopnea syndrome (obstructive sleep apnea-hypopnea syndrome, OSAHS) and central sleep apnea syndrome (central sleep apnea syndrome), sleep hypoventilation syndrome (sleep hypoventilation). Clinically, OSAHS is the most common, so this guide focuses on OSAHS. OSAHS is mainly associated with snoring and apnea and breathing shallow, repetitive nocturnal hypoxemia, hypercapnia and sleep disorder, excessive daytime sleepiness, cardiovascular and pulmonary complications and multiple organ damage, seriously affect the patient's quality of life and life. Foreign data show that the prevalence of OSAHS in adults 2% to 4%, is an independent risk factor for a variety of systemic diseases. At present, the majority of patients and medical workers to the disease severity, universality and importance of the lack of enough understanding, there are also many problems in clinical diagnosis and treatment, therefore need to develop guidelines for diagnosis and management corresponding to the specification often encountered in clinical work.
Definition of OSAHS related terms
1 sleep apnea (SA) refers to the process of sleep respiratory airflow was stopped for more than 10 seconds.
2 low ventilation refers to respiratory airflow during sleep intensity (amplitude) is reduced by more than 50% with a basic level of oxygen saturation (SaO2) decreased more than 4% compared to the baseline level.
3.OSAHS refers to 7h every night during sleep apnea and hypopnea recurrent in more than 30 times, or sleep apnea hypopnea index (apnea hypopnea index, AHI, the average per hour of sleep apnea plus hypopnea index) is greater than or equal to 5 /h.
4 refers to the process of awakening reflect sleep apnea causes because of awakening, it can be longer and the awakening of the total sleep time is shortened, can also cause frequent arousals and short but has yet to be included in the total time of awakening, but can lead to increased daytime sleepiness.
6 micro arousal refers to the change in the frequency of the 16Hz (EEG) that lasts for more than 3 seconds during sleep, including theta, alpha, and (or) more than half of the brain waves (but not spindle waves).
Two, the main hazard factors
1 fat: body weight exceeds the standard weight of 20% or above, body mass index (body mass, index, BMI) = 25%kg/m2.
2 age: the prevalence of age increased with the increase of age; the number of women after menopause increased, and the prevalence rate was stable after the age of 70.
3 gender: male patients were significantly more than women.
4 upper airway abnormalities including nasal congestion (nasal septum, turbinate hypertrophy, nasal polyps and nasal tumors), II. The above tonsil hypertrophy and soft palate relaxation, the uvula is too long, too thick, narrow pharynx, throat cancer, pharyngeal mucosal hypertrophy, tongue hypertrophy, tongue retropulsion, mandibular retrusion, temporomandibular joint dysfunction and micrognathia.
5 family history.
6 a large number of long-term drinking and (or) taking sedative hypnotic drugs.
7 long term heavy smoking.
8 other related diseases: hypothyroidism. Acromegaly, pituitary dysfunction, amyloidosis, vocal cord paralysis, infantile paralysis or other neuromuscular disorders (such as Bai Higginson disease), long-term gastroesophageal reflux etc..
Three, clinical features
During nocturnal sleep snoring and irregular snoring, breathing and sleep rhythm disorder, repeated apnea and arousal, or the patient conscious breath, nocturia, morning headache, daytime sleepiness, memory decline; hypertension, coronary heart disease, and pulmonary heart disease, stroke and other cardiovascular and cerebrovascular disease, and can have sex weight gain, serious person can appear heart, intelligence, abnormal behavior.
Four, physical examination and routine inspection items
1 height, weight, calculated index BMI = body weight (kg) / height 2 (M2).
2 physical examination: including neck, blood oxygen (before going to bed and wake up blood pressure), assessment of maxillofacial morphology, nasal cavity, throat examination, heart, lungs, brain, nervous system examination.
3 blood cell count, the red blood cell count, hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular red protein concentration (MCHC).
4 arterial blood gas analysis.
5 pulmonary function test.
6 x ray cephalometric (including throat measurement) and chest radiograph.
8 clinical manifestations of causes or risk factors.
9 possible complications.
The 10 part of the patient should check thyroid function.
Five, the main laboratory test methods
1 screening inspection apparatus: the use of portable, mostly by polysomnography (polysomnography, PSG) monitoring index of part of the portfolio, such as pure oxygen saturation monitoring, muzzle flow + muzzle flow oxygen saturation, oxygen saturation + + + snoring thoracoabdominal activities, mainly suitable for the basic patients or due to sleep the environment change or lead too much and not checked in sleep monitoring room for some patients with mild, except OSAHS or screening of OSAHS patients, but also can be applied to the comparison before and after treatment and patient follow-up.
2 polysomnography (polysomnography, PSG) monitoring: (1) overnight PSG monitoring: &ldquo diagnosis of OSAHS; gold standard ”. Including two EEG (EEG) by C3A2 and C4A1, two by EOG (EOG), electromyogram (EMG) and the mandibular symphysis electrocardiogram (ECG), mouth, nasal airflow. Thoracic and abdominal breathing exercise, oxygen saturation, posture, snoring, anterior tibial muscle EMG, regular monitoring generally requires not less than 7 hours of sleep a night. The indication for the clinical suspicion for OSAHS; the clinical symptoms and signs of other support with OSAHS, such as nocturnal asthma, lung or neuromuscular disorders affect sleep; the unexplained daytime hypoxemia or polycythemia; the unexplained nocturnal arrhythmia, nocturnal angina, hypertension in morning the monitoring of patients with sleep at night; the degree of hypoxia, and provide objective basis for oxygen therapy; therapeutic effect evaluation of the various means of treatment of OSAHS; the diagnosis of other sleep disorders. (2) PSG monitoring at night: PSG monitoring was performed at the first night of the same period from 2 to 4h, then the continuous positive airway pressure (continuous positive airway pressure, CPAP) pressure setting was carried out after 2 to 24 hours. The utility model has the advantages of reducing inspection and treatment costs, only recommended in the following cases: AHI>20 /h, repeated the longer duration of sleep apnea or hypopnea, accompanied by severe hypoxemia; the REM sleep due to late phase (rapid eye, movement, REM) sleep increased, CPAP titration time should be >3h when the patients were in the supine position, CPAP pressure can completely eliminate all REM and non REM sleep breathing pause, hypopnea and snoring. If you can not meet the above conditions, should be carried out overnight PSG monitoring and another night time CPAP titration. (3) PSG monitoring afternoon nap: for daytime sleepiness in patients with obvious can try, often need to ensure sleep time is 2 ~ 4H (including REM and NREM sleep) to meet the needs of the diagnosis of OSAHS, so there is a certain failure rate and false negative results.
Evaluation of 3 sleep level: (1) subjective evaluation of sleepiness: mainly Epworth Sleepiness Scale (Epworth Sleepiness Scale, ESS) and Standford sleepiness scale (Stanford Sleepiness Scale, SSS) see Appendix Table 1 is now using the ESS sleepiness scale. (2) objective assessment of sleepiness: objective assessment of daytime sleepiness in patients with suspected PSG.
Multiple sleep latency test (multiple sleep latency test, MSLT): an examination of the degree of daytime sleepiness by allowing patients to undergo a series of naps during the day. Once per hour, each nap lasted 30min, calculated the average latency of sleep and the number of abnormal REM sleep, sleep latency 10min were normal.
Six, the general diagnostic process shown in figure 1.
1 diagnostic criteria: mainly based on history, signs and PSG monitoring results. A typical nocturnal sleep snoring and irregular breathing, excessive daytime sleepiness in clinic, prompted by PSG monitoring every night during 7h sleep apnea and hypopnea recurrent in more than 30 times, or AHI is greater than or equal to 5 /h.
2.SAHS disease index: according to AHI and nocturnal oxygen saturation will be divided into light, medium and severe SAHS, see Table 1 in which AHI as the main criteria, the lowest SaO2 as a reference.